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The Royal College of Psychiatrists has established a Working Group on Choice in Mental Health and held a conference to include service users in formulating a challenging view of the choice agenda for mental health. This is set out here to stimulate wider interest. Choice-based practice develops in a climate of trust and information, and goes beyond simple variety or individual consumerism. For some service users, limited initial areas of choice can be of great importance, but a true culture of choice requires the widespread participation of service users and carers in service improvement. It is important that psychiatrists champion the empowerment of their patients through choice, in policy and training, and in clinical practice.

This editorial addresses the question of whether some of the basic tenets of the recovery model – optimism about outcome, the value of work, the importance of empowerment of patients and the utility of user-run programmes – are supported by the scientific research.

To establish whether cognitive-behavioural therapy (CBT) with response and exposure prevention (ERP) is effective in individuals with obsessive–compulsive disorder (OCD). Twenty-four patients with OCD, divided into four groups, participated in ten sessions of group CBT. All patients completed the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), the Maudsley Obsessive–Compulsive Inventory (MOCI), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) pre- and post-treatment.

Results

The mean (s.d.) YBOC score post-treatment was 17.1 (5.8). This was significantly lower than the mean (s.d.) YBOC pre-treatment (24.7 (6.1); t = 8.4, d.f. = 23, P < 0.005). A significant reduction was also observed in relation to all other rating scales.

Clinical implications

Cognitive–behavioural therapy for OCD delivered in a group setting is a clinically effective and acceptable treatment for patients. The use of group-based CBT is an effective means to improve access to psychotherapy.

To study the difference between high- and low-dose quetiapine in acute treatment of schizophrenia. Data available from published double-blind fixed-dose trials were combined and analysed.

Results

There was no statistically significant difference between high- (750–800 mg/day) and low-dose (300–400 mg/day) quetiapine in terms of the response rate, change in positive symptoms score and the discontinuation rates either as a result of lack of response or adverse effects.

Clinical implications

Combined evidence from fixed-dose trials does not support the prevalent practice of targeting the higher dose of quetiapine for optimal treatment response in schizophrenia.

Community treatment for individuals with personality disorder is a fast developing field. We report here on the effectiveness of one such approach. We examine the referral pathway of all clients between January 2005 and April 2008, including the mean days spent in our unit, the days spent in a psychiatric hospital before and after admission to our unit, and the results of changes in the rating scales we routinely use.

Results

Drop-out rates and the mean duration of therapy were acceptable. There has been a clear reduction of in-patient bed use and a small but significant improvement of most psychometric test results.

Clinical implications

This study provides further evidence for the effectiveness of community treatment for individuals with personality disorder.

To determine which terms receivers of mental health services wish to be known by (service user, patient, client, user, survivor) according to the professional consulted (psychiatrist, nurse, psychologist, social worker, occupational therapist). We conducted a questionnaire study to assess terms by like or dislike and by rank order. There were 336 participants from local catchment area secondary care community and in-patient settings in east Hertfordshire.

Results

Patient is the preferred term when consulted by psychiatrists and nurses, but it is equally preferable to client for social workers and occupational therapists. Service user is disliked more than liked overall, particularly by those who consulted a health professional, but not by those who consulted a social worker. A significant minority wish to be regarded as a survivor or user.

Clinical implications

National and local mental health services should adopt evidence-based terminology in referring to ‘patient’ or, in some groups, ‘patient or client’ in preference to ‘service user’.

To assess the contents and the theoretical and empirical base of community mental healthcare (CMHC) for people with severe personality disorder. Medline and PsycINFO databases and handbooks were searched from 1980, as well as a recent meta-analysis and systematic review of trials in which CMHC served as the control condition.

Results

Community mental healthcare is a long-term community-based treatment within a supportive atmosphere, aimed at stability rather than change. Mostly offered by community psychiatric nurses, occupational therapists and social workers, it lacks a formal structure, as well as theoretical underpinnings that guide interventions.

Clinical implications

Community mental healthcare might profit from a more systematic application of effective ingredients from other treatments.

Universities are the main provider of medical student education in the UK; however, its delivery, especially the clinical years but increasingly also the pre-clinical years, often takes place in National Health Service hospitals. Trusts are paid for this privilege through service increment for teaching (SIFT). Developments in clinical governance structures have meant that there is now increased scrutiny and transparency in the funding of clinical services. Lack of similarly robust educational governance structures has led to the risk of educational funds being used to deliver clinical services. This paper examines the current role of SIFT funding and the possible ways forward, using a case study.